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Supra-annular mitral valve replacement in children
Kirk R Kanter1, Brian E Kogon, Paul M Kirshbom
1Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia 30322, USA. kkanter@emory.edu
The Annals of Thoracic Surgery
|October 4, 2011
Summary
Supra-annular mitral valve replacement (MVR) is a viable option for children with small annuli, offering good operative survival. However, complications like reoperations and outflow tract obstruction are common, with pulmonary vein stenosis indicating a poorer prognosis.
Area of Science:
- Pediatric Cardiac Surgery
- Valvular Heart Disease
- Congenital Heart Defects
Background:
- Mitral valve replacement (MVR) is sometimes necessary in children despite advances in repair techniques.
- Small annular size in pediatric patients presents challenges for standard MVR procedures.
Purpose of the Study:
- To evaluate the efficacy and outcomes of supra-annular MVR in pediatric patients with small mitral annuli.
- To identify risk factors and complications associated with supra-annular MVR in this population.
Main Methods:
- A retrospective review of 15 children who underwent 23 supra-annular MVRs between 2003 and 2010.
- Analysis of patient demographics, pre-existing conditions, surgical details, and postoperative outcomes, including reoperations and survival rates.
Main Results:
- One early death (93% survival) occurred in a patient with congenital pulmonary vein stenosis.
- Complications included heart block, pacemaker implantation, and early valve thrombosis.
- Eight patients (53%) required reoperation, with six undergoing redo MVR for pannus or thrombus.
Conclusions:
- Supra-annular MVR is a useful technique for pediatric patients with small mitral annuli, demonstrating good operative survival.
- Complications are frequent, necessitating careful management and potential interventions.
- Pulmonary vein stenosis is associated with adverse outcomes, while its absence predicts long-term survival.
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